The new ESMO1 guidelines on biliary cancers2 were published in September 2016 as a supplement to the Annals of Oncology. Their lead author, Professor Juan Valle of the Christie NHS Foundation Trust, University of Manchester, states that SIRT, also known as radioembolisation, “may be considered in patients with inoperable iCCA, usually after first-line chemotherapy.”

Microcatheter releasing microspheres

The ESMO inclusion of SIRT for the treatment of intrahepatic cholangiocarcinoma was based on their review of a pooled analysis of 12 studies totalling 298 patients published in the European Journal of Surgical Oncology in 2015, by Dr D. P. Al-Adra of the University of Edmonton, Canada and others. These data showed a median overall survival of 15.5 months and treatment response rate of 28% in patients treated with SIRT.

10% of patients converted to resectable disease
In addition, the new ESMO guidelines on biliary cancers call special attention to a subset of studies in the pooled SIRT analysis, stating that “importantly, 7/73 (10%) patients in three selected studies were converted to resectable disease, highlighting the importance of reassessment of patients in the multidisciplinary team in the event of a good response to any treatment.”

Most iCCA patients are diagnosed relatively late in the course of their disease, and therefore are not immediately eligible for potentially curative surgical resection. The fact that even a small proportion of these patients may become surgically resectable after chemotherapy suggests that SIRT may offer real hope for them. This is a finding AMMF particularly welcomes.

The SIRCCA Study
There is a new international SIRT study, SIRCCA, currently in set up. This study will enrol 180 patients at more than 30 treatment centres in the UK, Belgium, France, Germany, Italy, Spain, The Netherlands and Australia. The principal investigators are Dr Harpreet Wasan in the UK (Hammersmith Hospital, Imperial College London) and in Spain, Professor Jordi Bruix (Barcelona Clinic).

More information about the SIRCCA trial can be found on AMMF’s website by clicking here